Comprehensive Long-Term Management Program for Asthma: Effect on Outcomes in Adult African-Americans
| Autor: | Tiffany M. Kelso, Nabil Abou-Shala, Tracy S. Portner, Timothy H. Self, Kristopher L. Arheart, Greta M. Heilker |
|---|---|
| Rok vydání: | 1996 |
| Předmět: |
Adult
medicine.medical_specialty Pediatrics Patient Education as Topic Quality of life Adrenal Cortex Hormones Prednisone Acute care medicine Humans Albuterol Anti-Asthmatic Agents Asthma business.industry Public health Beclomethasone General Medicine Emergency department medicine.disease Black or African American Hospitalization Treatment Outcome Quality of Life Drug Therapy Combination Health education Emergencies business Program Evaluation medicine.drug Patient education |
| Zdroj: | The American Journal of the Medical Sciences. 311:272-280 |
| ISSN: | 0002-9629 |
| DOI: | 10.1016/s0002-9629(15)41721-5 |
| Popis: | To determine if a comprehensive long-term management program, emphasizing inhaled corticosteroids and patient education, would improve outcomes in adult African-American asthmatics a nonrandomized control trial with a 2-year intervention was performed in a university-based clinic. Inclusion criteria consisted of (or = 5) emergency department (ED) visits or hospitalizations (or = 2) during the previous 2 years. Intervention patients were volunteers; a comparable control group was identified via chart review at hospitals within the same area and time period as the intervention patients. Individualized doses of beclomethasone with a spacer, inhaled albuterol "as needed," and crisis prednisone were the primary therapies. Environmental control, peak flow monitoring, and a partnership with the patient were emphasized. Detailed patient education was an integral part of management. Control patients received usual care from local physicians. ED visits and hospitalizations for 2 years before and 2 years during the intervention period were compared. Quality of life (QOL) measurements were made at baseline and every 6 months in the intervention group. Study group (n = 21) had a significant reduction in ED visits (2.3 +/- 0.2 pre-intervention versus 0.6 +/- 0.2 post-intervention; P = 0.0001). Control group (n = 18) did not have a significant change in ED visits during the 2-year post-intervention period (2.6 +/- 0.2 pre-intervention versus 2.0 +/- 0.2 post-intervention; P = 0.11). Both groups had significant reductions in hospitalizations, but the study group had a greater reduction. Sixty-two percent of study patients had complete elimination of ED visits and hospitalizations, whereas no control patients had total elimination of the need for institutional acute care. QOL in the study patients revealed significant improvements for most parameters. A comprehensive long-term management program emphasizing inhaled corticosteroids combined with other state-of-the-art management, including intensive patient education, improves outcomes in adult African-American asthmatics. |
| Databáze: | OpenAIRE |
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